Neural Basis of the Sound-Symbolic Crossmodal Correspondence Between Auditory Pseudowords and Visual Shapes.

Sound symbolism refers to the association between the sounds of words and their meanings, often studied using the crossmodal correspondence between auditory pseudowords, e.g., 'takete' or 'maluma', and pointed or rounded visual shapes, respectively. In a functional magnetic resonance imaging study, participants were presented with pseudoword-shape pairs that were sound-symbolically congruent or incongruent. We found no significant congruency effects in the blood oxygenation level-dependent (BOLD) signal when participants were attending to visual shapes. During attention to auditory pseudowords, however, we observed greater BOLD activity for incongruent compared to congruent audiovisual pairs bilaterally in the intraparietal sulcus and supramarginal gyrus, and in the left middle frontal gyrus. We compared this activity to independent functional contrasts designed to test competing explanations of sound symbolism, but found no evidence for mediation via language, and only limited evidence for accounts based on multisensory integration and a general magnitude system. Instead, we suggest that the observed incongruency effects are likely to reflect phonological processing and/or multisensory attention. These findings advance our understanding of sound-to-meaning mapping in the brain.

Stimulus Parameters Underlying Sound-Symbolic Mapping of Auditory Pseudowords to Visual Shapes.

Sound symbolism refers to non-arbitrary mappings between the sounds of words and their meanings and is often studied by pairing auditory pseudowords such as "maluma" and "takete" with rounded and pointed visual shapes, respectively. However, it is unclear what auditory properties of pseudowords contribute to their perception as rounded or pointed. Here, we compared perceptual ratings of the roundedness/pointedness of large sets of pseudowords and shapes to their acoustic and visual properties using a novel application of representational similarity analysis (RSA). Representational dissimilarity matrices (RDMs) of the auditory and visual ratings of roundedness/pointedness were significantly correlated crossmodally. The auditory perceptual RDM correlated significantly with RDMs of spectral tilt, the temporal fast Fourier transform (FFT), and the speech envelope. Conventional correlational analyses showed that ratings of pseudowords transitioned from rounded to pointed as vocal roughness (as measured by the harmonics-to-noise ratio, pulse number, fraction of unvoiced frames, mean autocorrelation, shimmer, and jitter) increased. The visual perceptual RDM correlated significantly with RDMs of global indices of visual shape (the simple matching coefficient, image silhouette, image outlines, and Jaccard distance). Crossmodally, the RDMs of the auditory spectral parameters correlated weakly but significantly with those of the global indices of visual shape. Our work establishes the utility of RSA for analysis of large stimulus sets and offers novel insights into the stimulus parameters underlying sound symbolism, showing that sound-to-shape mapping is driven by acoustic properties of pseudowords and suggesting audiovisual cross-modal correspondence as a basis for language users' sensitivity to this type of sound symbolism.

Neural basis of the crossmodal correspondence between auditory pitch and visuospatial elevation.

Crossmodal correspondences refer to associations between otherwise unrelated stimulus features in different sensory modalities. For example, high and low auditory pitches are associated with high and low visuospatial elevation, respectively. The neural mechanisms underlying crossmodal correspondences are currently unknown. Here, we used functional magnetic resonance imaging (fMRI) to investigate the neural basis of the pitch-elevation correspondence. Pitch-elevation congruency effects were observed bilaterally in the inferior frontal and insular cortex, the right frontal eye field and right inferior parietal cortex. Independent functional localizers failed to provide strong evidence for any of three proposed mechanisms for crossmodal correspondences: semantic mediation, magnitude estimation, and multisensory integration. Instead, pitch-elevation congruency effects overlapped with areas selective for visually presented non-word strings relative to sentences, and with regions sensitive to audiovisual asynchrony. Taken together with the prior literature, the observed congruency effects are most consistent with mediation by multisensory attention.

Engagement of the left extrastriate body area during body-part metaphor comprehension.

Grounded cognition explanations of metaphor comprehension predict activation of sensorimotor cortices relevant to the metaphor's source domain. We tested this prediction for body-part metaphors using functional magnetic resonance imaging while participants heard sentences containing metaphorical or literal references to body parts, and comparable control sentences. Localizer scans identified body-part-specific motor, somatosensory and visual cortical regions. Both subject- and item-wise analyses showed that, relative to control sentences, metaphorical but not literal sentences evoked limb metaphor-specific activity in the left extrastriate body area (EBA), paralleling the EBA's known visual limb-selectivity. The EBA focus exhibited resting-state functional connectivity with ipsilateral semantic processing regions. In some of these regions, the strength of resting-state connectivity correlated with individual preference for verbal processing. Effective connectivity analyses showed that, during metaphor comprehension, activity in some semantic regions drove that in the EBA. These results provide converging evidence for grounding of metaphor processing in domain-specific sensorimotor cortical activity.

Synesthesia strengthens sound-symbolic cross-modal correspondences.

Synesthesia is a phenomenon in which an experience in one domain is accompanied by an involuntary secondary experience in another, unrelated domain; in classical synesthesia, these associations are arbitrary and idiosyncratic. Cross-modal correspondences refer to universal associations between seemingly unrelated sensory features, e.g., auditory pitch and visual size. Some argue that these phenomena form a continuum, with classical synesthesia being an exaggeration of universal cross-modal correspondences, whereas others contend that the two are quite different, since cross-modal correspondences are non-arbitrary, non-idiosyncratic, and do not involve secondary experiences. Here, we used the implicit association test to compare synesthetes' and non-synesthetes' sensitivity to cross-modal correspondences. We tested the associations between auditory pitch and visual elevation, auditory pitch and visual size, and sound-symbolic correspondences between auditory pseudowords and visual shapes. Synesthetes were more sensitive than non-synesthetes to cross-modal correspondences involving sound-symbolic, but not low-level sensory, associations. We conclude that synesthesia heightens universally experienced cross-modal correspondences, but only when these involve sound symbolism. This is only partly consistent with the idea of a continuum between synesthesia and cross-modal correspondences, but accords with the idea that synesthesia is a high-level, post-perceptual phenomenon, with spillover of the abilities of synesthetes into domains outside their synesthesias. To our knowledge, this is the first demonstration that synesthetes, relative to non-synesthetes, experience stronger cross-modal correspondences outside their synesthetic domains.

Preventability of Pediatric 30-Day Readmissions following Ventricular Shunt Surgery.

OBJECTIVE: To compare the preventability of 30-day pediatric ventricular shunt readmissions using clinical and administrative data review. STUDY DESIGN: We performed a retrospective chart review of one hundred forty-seven 30-day ventricular shunt readmissions at a tertiary pediatric center from May 2009-April 2013 under 2 scenarios: scenario 1 considered all ventricular shunt failures preventable; and scenario 2 considered shunt failures with excellent/good catheter positioning and no contributing deficiencies in care not preventable. Three physician reviewers independently assessed readmissions to determine their preventability and whether deficiencies in care existed that contributed to the readmission. We also evaluated the degree of interrater agreement in adjudicating readmission preventability. RESULTS: Only 42% of 30-day readmissions following ventricular shunt procedures were preventable when considering all shunt failures as preventable. When classifying shunts with excellent/good proximal catheter position as not preventable, 21% of ventricular shunt readmissions were deemed preventable. Interrater agreement on readmission preventability was high (kappa 0.88). Deficiencies in care existed in 29 readmissions (20%), the largest category being physician related, but not all deficiencies contributed to a readmission. CONCLUSIONS: Significant discrepancy exists in the preventability adjudication of ventricular shunt readmissions between administrative and chart review. Although using administrative data has determined that a majority of readmissions following pediatric ventricular shunt procedures are preventable, our review suggests a significantly lower degree of preventability.

Impact of Physician Scorecards on Emergency Department Resource Use, Quality, and Efficiency.

BACKGROUND AND OBJECTIVES: Variability in practice patterns and resource use in the emergency department (ED) can affect costs without affecting outcomes. ED quality measures have not included resource use in relation to ED outcomes and efficiency. Our objectives were to develop a tool for comprehensive physician feedback on practice patterns relative to peers and to study its impact on resource use, quality, and efficiency. METHODS: We evaluated condition-specific resource use (laboratory tests; imaging; antibiotics, intravenous fluids, and ondansetron; admission) by physicians at 2 tertiary pediatric EDs for 4 common conditions (fever, head injury, respiratory illness, gastroenteritis). Resources used, ED length of stay (efficiency measure), and 72-hour return to ED (return rate [RR]) (balancing measure) were reported on scorecards with boxplots showing physicians their practice relative to peers. Quarterly scorecards were distributed for baseline (preintervention, July 2009-August 2010) and postintervention (September 2010-December 2011). Preintervention, postintervention, and trend analyses were performed. RESULTS: In 51 450 patient visits (24 834 preintervention, 26 616 postintervention) seen by 96 physicians, we observed reduced postintervention use of abdominal and pelvic and head computed tomography scans, chest radiographs, intravenous antibiotics, and ondansetron (P < .01 for all). Hospital admissions decreased from 7.4% to 6.7% (P = .002), length of stay from 112 to 108 minutes (P < .001), and RR from 2.2% to 2.0%. Trends for use of laboratory tests and intravenous antibiotics showed significant reduction (P < .001 and P < .05, respectively); admission trends increased, and trends for use of computed tomography scans and plain abdominal radiographs showed no change. CONCLUSIONS: Physician feedback on practice patterns relative to peers results in reduction in resource use for several common ED conditions without adversely affecting ED efficiency or quality of care.

Cigarette smoking increases complication rate in forefoot surgery.

BACKGROUND: Cigarette smoking is known to increase perioperative complication rates, but no study to date has examined its effect specifically in forefoot surgery. The purpose of this study was to determine whether cigarette smoking increased complications after forefoot surgery. METHODS: The records of 602 patients who had forefoot surgery between 2008 and 2010, and for whom smoking status was known, were reviewed. Patients were categorized into 3 groups based on smoking status: active smoker, smoker in the past, or nonsmoker. Medical records were reviewed for occurrence of complications, including nonunion, delayed union, delayed wound healing, infection, and persistent pain. RESULTS: Active smokers were found to have a notably higher complication rate (36.4%) after forefoot surgery than patients who previously (16.5%) or never (8.5%) smoked. Patients who continued to smoke in the perioperative period had the highest percentage of delayed union (3.0%), infection (9.1%), delayed wound healing (10.6%), and persistent pain (15.2%). Active cigarette smokers were 4.3 times more likely to have a complication than nonsmokers. Patients who smoked at any point in the past but quit prior to surgery were 1.9 times more likely than nonsmokers to incur a complication. The average time of smoking cessation for patients who had smoked at any point in the past but had quit prior to surgery was 17 years. For active smokers, those with a complication smoked an average of 18 cigarettes daily, while those without a complication smoked 14 cigarettes daily. CONCLUSIONS: Before forefoot surgery, surgeons should educate patients who smoke about their increased risk of complications and encourage smoking cessation. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Surveillance for respiratory health care-associated infections among inpatients in 3 Kenyan hospitals, 2010-2012.

BACKGROUND: Although health care-associated infections are an important cause of morbidity and mortality worldwide, the epidemiology and etiology of respiratory health care-associated infections (rHAIs) have not been documented in Kenya. In 2010, the Ministry of Health, Kenya Medical Research Institute, and Centers for Disease Control and Prevention initiated surveillance for rHAIs at 3 hospitals. METHODS: At each hospital, we surveyed intensive care units (ICUs), pediatric wards, and medical wards to identify patients with rHAIs, defined as any hospital-onset (≥3 days after admission) fever (≥38°C) or hypothermia (<35°C) with concurrent signs or symptoms of acute respiratory infection. Nasopharyngeal and oropharyngeal specimens were collected from these patients and tested by real-time reverse transcription polymerase chain reaction for influenza and 7 other viruses. RESULTS: From April 2010-September 2012, of the 379 rHAI cases, 60.7% were men and 57.3% were children <18 years old. The overall incidence of rHAIs was 9.2 per 10,000 patient days, with the highest incidence in the ICUs. Of all specimens analyzed, 45.7% had at least 1 respiratory virus detected; 92.2% of all positive viral specimens were identified in patients <18 years old. CONCLUSION: We identified rHAIs in all ward types under surveillance in Kenyan hospitals. Viruses may have a substantial role in these infections, particularly among pediatric populations. Further research is needed to refine case definitions and understand rHAIs in ICUs.

Perspectives on Federal Funding for State Health Care-Associated Infection Programs: Achievements, Barriers, and Implications for Sustainability.

In September 2009, federal funding for health care-associated infection (HAI) program development was dispersed through a cooperative agreement to 51 state and territorial health departments. From July to September 2011, 69 stakeholders from six states-including state health department employees, representatives from partner organizations, and health care facility employees-were interviewed to assess state HAI program achievements, implementation barriers, and strategies for sustainability. Respondents most frequently cited enhanced HAI surveillance as a program achievement and resource constraints as an implementation barrier. To sustain programs, respondents recommended ongoing support for HAI prevention activities, improved surveillance processes, and maintenance of partnerships. Findings suggest that state-level HAI program growth was achieved during the cooperative agreement but that maintenance of programs faces challenges.

Enhancement of health department capacity for health care-associated infection prevention through Recovery Act-funded programs.

OBJECTIVES: We evaluated capacity built and outcomes achieved from September 1, 2009, to December 31, 2011, by 51 health departments (HDs) funded through the American Recovery and Reinvestment Act (ARRA) for health care-associated infection (HAI) program development. METHODS: We defined capacity for HAI prevention at HDs by 25 indicators of activity in 6 categories: staffing, partnerships, training, technical assistance, surveillance, and prevention. We assessed state-level infection outcomes by modeling quarterly standardized infection ratios (SIRs) for device- and procedure-associated infections with longitudinal regression models. RESULTS: With ARRA funds, HDs created 188 HAI-related positions and supported 1042 training programs, 53 surveillance data validation projects, and 60 prevention collaboratives. All states demonstrated significant declines in central line-associated bloodstream and surgical site infections. States that implemented ARRA-funded catheter-associated urinary tract infection prevention collaboratives showed significantly greater SIR reductions over time than states that did not (P = .02). CONCLUSIONS: ARRA-HAI funding substantially improved HD capacity to reduce HAIs not targeted by other national efforts, suggesting that HDs can play a critical role in addressing emerging or neglected HAIs.

The role of the public health analyst in the delivery of technical assistance to state health departments for healthcare-associated infection prevention.

INTRODUCTION: Aligned with the goals of the DHHS Action Plan to Prevent Healthcare Associated Infections (HAIs), in 2009 the Centers for Disease Control and Prevention (CDC) awarded cooperative agreements to 51 state and territorial health departments for purposes of developing and implementing strategies to reduce HAIs. These cooperative agreements through the Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) were supported by the American Recovery and Reinvestment Act (ARRA). OBJECTIVES: To systematically describe the perceptions of CDC public health analysts who delivered technical assistance (TA) to state health departments as part of the ELC cooperative agreement supported by ARRA to develop, implement, and/or expand HAI prevention programs. RESEARCH DESIGN: Eight semistructured interviews using a standardized script were administered. Interviews were audio recorded; responses were transcribed, thematically coded, and analyzed using a qualitative immersion approach. SUBJECTS: This study included CDC staff who provided TA to grantees of the ELC cooperative agreement supported by ARRA from September 2009 to December 2011. RESULTS: Four convergent themes were identified, creating a framework of activities for the delivery of TA: acting as a liaison, facilitating training, providing administrative and program management support, and sharing/disseminating information to states. Having a liaison and providing informational resources to states were perceived as critical components of TA for HAI program sustainability. CONCLUSIONS: Findings provide a framework of core TA activities required to build and sustain capacity in state HAI prevention programs through the cooperative agreement structure. This categorization of themes can be used to assist other agencies and entities in planning for and provision of TA when utilizing cooperative agreements.

Current trends in outpatient pharmacy services and billing.

OBJECTIVES: To provide a summary of community and ambulatory pharmacy practices and billing patterns for medication therapy management (MTM) services and to identify reasons pharmacists report not billing for direct patient care services. DESIGN: Cross-sectional study. SETTING: United States, February 2011. PARTICIPANTS: Members of the American College of Clinical Pharmacy Ambulatory Care Practice and Research Network, American Society of Health-System Pharmacists Ambulatory and Chronic Care Practitioners, and American Pharmacists Association MTM e-community. INTERVENTION: Online survey. MAIN OUTCOME MEASURES: Practice setting, pharmacy services performed, billing technique, and payer, as well as reasons for not billing. RESULTS: MTM services were provided by 287 pharmacists. The most common practice settings included physician office (23.6%), health-system outpatient facility (21.7%), and community pharmacy (20.2%). A total of 149 of 276 pharmacists (54.0%) reported billing for MTM services; 16 of 276 (5.8%) did not know if they were currently billing. Community pharmacists were more likely to bill than all other sites combined (80.5% vs. 53.1%, P < 0.001), and pharmacists with >75% of visits face-to-face were more likely to bill (66.2% vs. 46.6%, P < 0.002). CONCLUSION: A variety of MTM services are provided in outpatient settings with inconsistent billing techniques and reimbursement. Pharmacists should continue to work toward consistent, sustainable reimbursement to expand MTM services.

How linguistic and cultural forces shape conceptions of time: English and Mandarin time in 3D.

In this paper we examine how English and Mandarin speakers think about time, and we test how the patterns of thinking in the two groups relate to patterns in linguistic and cultural experience. In Mandarin, vertical spatial metaphors are used more frequently to talk about time than they are in English; English relies primarily on horizontal terms. We present results from two tasks comparing English and Mandarin speakers' temporal reasoning. The tasks measure how people spatialize time in three-dimensional space, including the sagittal (front/back), transverse (left/right), and vertical (up/down) axes. Results of Experiment 1 show that people automatically create spatial representations in the course of temporal reasoning, and these implicit spatializations differ in accordance with patterns in language, even in a non-linguistic task. Both groups showed evidence of a left-to-right representation of time, in accordance with writing direction, but only Mandarin speakers showed a vertical top-to-bottom pattern for time (congruent with vertical spatiotemporal metaphors in Mandarin). Results of Experiment 2 confirm and extend these findings, showing that bilinguals' representations of time depend on both long-term and proximal aspects of language experience. Participants who were more proficient in Mandarin were more likely to arrange time vertically (an effect of previous language experience). Further, bilinguals were more likely to arrange time vertically when they were tested in Mandarin than when they were tested in English (an effect of immediate linguistic context).

Do English and Mandarin speakers think about time differently?

Time is a fundamental domain of experience. In this paper we ask whether aspects of language and culture affect how people think about this domain. Specifically, we consider whether English and Mandarin speakers think about time differently. We review all of the available evidence both for and against this hypothesis, and report new data that further support and refine it. The results demonstrate that English and Mandarin speakers do think about time differently. As predicted by patterns in language, Mandarin speakers are more likely than English speakers to think about time vertically (with earlier time-points above and later time-points below).

Nonoperative treatment of distal biceps tendon ruptures compared with a historical control group.

BACKGROUND: Few data are available regarding the results of nonoperative treatment of distal biceps ruptures. The present study was designed to assess the outcomes associated with unrepaired distal biceps tendon ruptures. METHODS: Eighteen patients with twenty unrepaired distal biceps tendon ruptures were assessed retrospectively. The median duration of follow-up was thirty-eight months. Sixteen of the eighteen patients were male, and the median age at the time of the injury was fifty years (range, thirty-five to seventy-four years). Supination strength and elbow flexion strength were measured bilaterally, and patient outcomes were assessed with use of the Broberg and Morrey Functional Rating Index, the Mayo Elbow Performance Index, and the Disabilities of the Arm, Shoulder and Hand questionnaire. Data were compared with historical controls compiled from six published series of operatively treated patients. RESULTS: The median supination and elbow flexion strengths for the injured arm were 63% (mean, 74%; range, 33% to 162%) and 93% (mean, 88%; range, 58% to 110%) of those for the contralateral arm, compared with values of 92% (mean, 101%; range, 42% to 297%) and 95% (mean, 97%; range, 53% to 191%) for the historical controls that had been treated surgically. The difference between the mean values was significant for supination strength (p = 0.002) but not for flexion strength (p = 0.164). Patients had satisfactory outcomes overall, with median scores on the Broberg and Morrey Functional Rating Index, the Mayo Elbow Performance Index, and the Disabilities of the Arm, Shoulder and Hand questionnaire of 85, 95, and 9, respectively. CONCLUSIONS: Nonoperative treatment of distal biceps tendon ruptures can yield acceptable outcomes with modestly reduced strength, especially supination.

Meniscal repair of the knee.

Since King's research on knee degeneration, meniscal-sparing techniques and other significant advances have improved outcomes. The anatomy, classification, and biomechanics of menisci are reviewed. Although the majority of traumatic meniscal damage occurs to the medial meniscus during twisting-type injuries, modern surgeons should be prepared to deal with patients of all ages with varied symptoms and mechanisms of injury. Non-operative versus operative treatments depend on many variables including the location of tear, age, and knee stability. If surgery is indicated, open and various arthroscopic techniques are available. Post-operative management and rehabilitation should be considered vital parts to any successful meniscal repair.